Psoriasis Australia

Inverse Psoriasis

Inverse psoriasis, also known as flexural psoriasis, is a form of psoriasis that primarily affects skin folds and areas where the skin rubs against itself.

Overview

Inverse psoriasis, also known as flexural psoriasis, is a form of psoriasis that primarily affects skin folds and areas where the skin rubs against itself. These regions include the armpits, groin, under the breasts, buttocks, and around the genitals. The lesions typically appear as smooth, shiny, and red patches without the thick scaling commonly associated with other forms of psoriasis like plaque psoriasis. Due to its location in sensitive areas, inverse psoriasis can be particularly uncomfortable and prone to irritation, exacerbating symptoms.

Symptoms

Unlike plaque psoriasis, which produces thick, scaly lesions, inverse psoriasis is characterized by:

  • Smooth, red patches: The affected areas are typically shiny and inflamed but lack the scales seen in other psoriasis types.
  • Location in skin folds: Commonly found in areas such as the groin, under the breasts, armpits, and around the genitals.
  • Increased irritation: The constant friction between skin folds makes the affected regions more sensitive to discomfort and itching.
  • Secondary infections: Since these areas are often warm and moist, they are more susceptible to fungal or bacterial infections.

Causes

Inverse psoriasis, like other forms of psoriasis, is a chronic inflammatory condition driven by the immune system. In individuals with psoriasis, the immune system mistakenly attacks healthy skin cells, causing an overproduction of skin cells and the associated inflammation. The following factors are believed to contribute to inverse psoriasis:

  • Genetics: A family history of psoriasis increases the risk of developing the condition.
  • Environmental Triggers: Hot weather, sweating, and friction from clothing can worsen symptoms, especially in Australia’s warm climate.
  • Obesity: The risk of developing inverse psoriasis is higher in individuals who are overweight or obese due to more prominent skin folds, which can trap moisture and cause irritation.
  • Infections: Yeast infections, particularly Candida, are more common in the skin folds affected by inverse psoriasis, potentially triggering flare-ups

Diagnosis

Diagnosing inverse psoriasis usually involves a physical examination by a dermatologist. They may assess the appearance of the lesions and their location in the skin folds. Occasionally, a biopsy may be taken to rule out other skin conditions like fungal infections or intertrigo.

Treatment

1. Topical Treatments

  • Corticosteroids: Low-strength topical corticosteroids (e.g., hydrocortisone) are commonly used to reduce inflammation and redness. Inverse psoriasis areas are particularly sensitive, so mild formulations are preferred to avoid thinning of the skin.
  • Calcineurin Inhibitors: Medications like tacrolimus and pimecrolimus are often used in sensitive areas, as they do not cause skin thinning. They are particularly effective in managing inflammation and are approved for use in Australia.
  • Antifungal and Antibacterial Treatments: If a secondary infection is present, topical antifungal (e.g., clotrimazole) or antibacterial treatments may be prescribed.
  • Moisturizers and Emollients: These are used to keep the skin hydrated and reduce friction, which can help alleviate symptoms.

2. Phototherapy

While phototherapy (UV light treatment) is less commonly used for inverse psoriasis than for plaque psoriasis, it may be considered in severe cases. It is essential to note that phototherapy may be challenging to apply in skin folds and sensitive areas.

3. Systemic Treatments

In more severe or widespread cases, systemic treatments may be prescribed. These treatments aim to suppress the immune system’s activity to reduce inflammation:

  • Oral Medications: Methotrexate, acitretin, and cyclosporine are examples of oral treatments that can help manage more extensive or persistent inverse psoriasis.
  • Biologics: Biologic medications, such as adalimumab or secukinumab, specifically target parts of the immune system responsible for psoriasis. They are increasingly used in Australia to treat moderate to severe psoriasis, including inverse psoriasis.

Lifestyle and Home Care Tips

You can incorporate the following strategies to help manage your inverse psoriasis:

  • Keep the area dry: Use absorbent powders in skin folds to reduce moisture.
  • Wear loose-fitting clothing: This helps minimize friction and sweating, reducing irritation in affected areas.
  • Maintain a healthy weight: Reducing skin folds by losing weight may lessen symptoms for those who are overweight.
  • Regular skincare: Applying emollients and avoiding harsh soaps can keep the skin hydrated and help prevent flare-ups.

Overview

Inverse psoriasis is a unique form of psoriasis that requires careful management due to its location in sensitive areas of the body. With the right combination of treatments and lifestyle modifications, it is possible to manage the symptoms effectively and maintain a good quality of life. A dermatologist can offer a range of treatment options tailored to individual needs, and ongoing research continues to improve patient outcomes.